Stacee Lerret PhD, RN, CPNP, CCTCMedical College of WisconsinChildren’s Hospital of WisconsinWI ITNS Annual ConferenceOctober 13, 2012

MOVING ON UP: PEDIATRIC TO ADULT TRANSITION

FINANCIAL DISCLOSURE

None to report

Review current state of transition in solid organ transplant and other chronic illness populations.

Identify obstacles to a successful transition process for solid organ transplant recipients.

Identify transition practices and resources currently used at transplant centers.

OBJECTIVES

Growing number of chi ldren with complex health condit ions

Transfer from pediatr ic to adult faci l i ty is another milestone

MILESTONES

Definition“Purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health care systems”.

Blum et al., 1993

INTRODUCTION

Transition• Active process that addresses needs of

adolescents as they prepare to move from child to adult centered health care• Medical• Psychosocial• Educational/Vocational

Transfer• Physical change in location where care is

provided

DEFINITIONS

Blum et al., 1993; Sawyer et al., 1997

LiteratureSolid organ transplant Human immunodeficiency virus

Cystic fibrosisDiabetesOther chronic illness populations

National practice and research priority

TRANSITION LITERATURE

TRANSITION LITERATURE: CONSENSUS STATEMENTS

Formal framework for enabling the seamless transition of transplant patients for all healthcare providers to follow.Age of transfer is individualized and transfer takes place during the transition process age range 14-24 years.Every patient should be offered the opportunity of participating in a young adult clinic.

Pediatric and adult centers should identify a clinical lead.

Process of consultation with patients and families to ensure all needs are met.During transfer patients should have access to support service tailored to their specific needs in the adult center.Performance standards are defined and monitored to ensure all patients receive similar service.

TRANSITION LITERATURE:CONSENSUS STATEMENTS

35 pediatric and 24 adult liver transplant coordinatorsResults highlight important role of communication

and partnership between pediatric and adult programs

TRANSITION: COORDINATOR PERSPECTIVE

Despite literature and momentum to improve transition process limitations exist Overall lack of

consistency in healthcare and support services provided to young adults and their families

Insufficiencies may be related to adverse outcomes Acute rejection Graft loss

TRANSITION LITERATURE CONT.

Patient

Family

Pediatric Team

Adult Team

Hospital Systems

OBSTACLES TO SUCCESSFUL TRANSITION

•Education at an early age•Foster responsibility and autonomy•Individualized to development and acuity

•Address fear and anxiety

Patient

•Encourage inclusion of child at an early age•Provide suggestions for enhancing independence•Include in process of choosing adult providerFamily

OVERCOMING TRANSITION OBSTACLES

•Promote age appropriate responsibilities•Coordinate and communicate with adult center

Pediatric Team

•Coordinate and communicate with adult center•Increase frequency of clinic appointments after transfer•Encourage adult primary care provider

Adult Team

•Transition policy•Support for dedicated individuals focusing on transition•Utilize experts for financial and insurance issues•Timing of transfer (age)Systems

OVERCOMING TRANSITION OBSTACLES

NOW WHAT?

One visit

• Adult MD or RN meeting family at pediatric facility

Alternating visits

• Pediatric and adult facility

TRANSITION CLINICS

TRANSITION RESOURCES

American Society of Transplantation

National Health Care Transition Center http://www.gottransition.org/ Got Transition Partnership

National Alliance to Advance Adolescent Health American Academy of Pediatrics

Target Health care professionals Families Youth Health policy makers

Content Transition tools and tips

RESOURCES: GOT TRANSITION

RESOURCES: GOT TRANSITION CONT.

TRANSITION RESOURCESThe Hospital for Sick Children, Toronto

http://www.sickkids.ca/Good2Go/

TRANSITION RESOURCES“GOOD 2 GO”

http://www.sickkids.ca/Good2Go/

TRANSITION RESOURCES“GOOD 2 GO”

http://www.sickkids.ca/Good2Go/

TRANSITION RESOURCES“GOOD 2 GO”

http://www.sickkids.ca/Good2Go/

TRANSITION RESOURCES“GOOD 2 GO”

http://www.sickkids.ca/Good2Go/

TRANSITION RESOURCES: READINESS CHECKLIST

Sawicki, 2011

TRANSITION RESOURCES: READINESS SURVEY

Fredericks et al., 2010

Important transplant and chronic illness issue Goal to maximize health and

quality of life Live as independent and self

sufficient adultsLiterature regarding transition

Currently have single center experiences published in literature

More rigorous research Limitations remain

Guide or framework Checklists built into electronic

medical recordNational efforts

Consensus group Transition workgroups

CONCLUSION

Discussion and

Questions